Automatic Cardioverter Defibrillator Implantation

Definition

An implantable cardioverter defibrillator (ICD) is a small, battery-operated device that monitors the heart’s rhythm and provides appropriate treatment. Most ICDs have both pacemaker and defibrillator functions. If the heart beats too slowly, the ICD can help the heart beat at a normal pace. If the heart begins to beat in a disorganized way, the device provides a shock to restore a normal rhythm. ICD implantation is the surgical insertion of an ICD.

Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.

The night before, eat a light meal. Do not eat or drink anything after midnight.

Ask your doctor if you should take your daily medications with a sip of water on the day of the procedure.

Anesthesia

For the implantation of the ICD, light sedation and a local anesthesia will usually be used.

After the ICD is in place, it will need to be tested.
General anesthesia
will be used for this step.

Description of the Procedure

The area where the ICD is to be implanted will be washed with antiseptic. A small incision will be made below the collarbone on the left or right side.

A wire, called a lead, will be threaded through a vein in the upper chest to the heart. An x-ray monitor will be used to watch the lead move through the vein to the heart. The signals between the heart and the ICD will be carried on this lead.

A pocket will be created under the skin at the incision site. The ICD will be implanted into the pocket.

When the ICD is in place, the sedation will be increased. The ICD will be tested to make sure that it shocks the heart appropriately. Every precaution will be taken to ensure that this is a safe process. When it is determined the ICD is working properly and in the right place, the incision will be closed with stitches.

Immediately After Procedure

You will be taken to a recovery room after the procedure. Your pulse, blood pressure, and incision site will be checked regularly. Chest x-rays will ensure the ICD and leads are in the proper place.

How Long Will It Take?

About 1-3 hours

How Much Will It Hurt?

You may feel some pushing and tugging on the skin during the procedure. The anesthesia should minimize any pain. After the procedure, you may experience some pain or stiffness at the incision site. Pain medication may be prescribed.

Average Hospital Stay

1-3 days

Postoperative Care

At the Hospital

The day after your implant, you will have an ECG and blood tests. The ICD function may be checked again. This will require sedation.

Do not carry a cell phone in a pocket directly over the device. Keep your phone on the side away from the device. Also, headphones worn with MP3 players may cause interference.

Turn off car or boat motors when working on them. They may temporarily confuse your device.

Tell your doctor or dentist that you have a device before a surgical procedure.

Check with your doctor about the safety of going through airport security detectors with your particular device. Do not linger in security devices.

Be sure to follow your doctor’s
instructions.

You will get an ID card that contains important information about your ICD. It is important that you show this card to any doctor, nurse, dentist, or other healthcare professional at the beginning of an office visit or hospital admission.

If your heart requires a shock from your ICD, you may be able to feel it. You may feel lightheaded before the shock. This is from the heart rhythm. The shock administered by the ICD may feel like a light thump or a strong kick in the chest. If you feel a shock, try to stay calm and sit or lie down. If someone is with you, ask him or her to stay. If you feel okay after the shock, contact your doctor’s office to let them know. This is not an emergency. Your doctor may want you to come in for a check-up, particularly if this is the first shock you have received. If you receive multiple shocks in a row or multiple shocks in a day, you should go to the emergency room.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

You feel a shock

Signs of infection, including fever and chills

Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site

Pain that you cannot control with the medicines you have been given

Cough or severe nausea or vomiting

These symptoms are medical emergencies. Call for medical help right away if you:

Have chest pain or shortness of breath

Feel lightheaded and do not feel a shock

You are still feeling symptoms after a shock

You feel 3 or more shocks in a row

In case of an emergency, call for emergency medical services right away.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

American College of Cardiology Foundation and the American Heart Association. ACC/AHA guideline update for implantation of cardiac pacemakers and antiarrhythmic devices. American Heart Association website. Available at:
http://circ.ahajournals.org/content/106/16/2145.full.pdf+html. Accessed June 9, 2016.